The irony continues. The federal government is “shut down” but health insurance exchanges at the center of the law that provoked Republicans to hold the country hostage have been up and running, and attracting a lot of interest. Although there have been some well-publicized (and expected) technical glitches, millions of people have visited State and Federal websites to learn more about their options for purchasing health insurance.

At the same time, the New York Times reported this week that millions of other citizens, who have incomes too low to qualify for subsidized private insurance on the exchanges, will continue to be uninsured. Remember that the Affordable Care Act was designed to expand health insurance coverage in two ways: for those with the lowest incomes, states were offered new funds from the federal government to expand Medicaid, which would have covered nearly all of the new expense at the outset, and about 90% thereafter. For those with higher incomes, the exchanges were created to provide new access to private insurance and subsidies based on income.

When the Supreme Court ruled on the constitutionality of the ACA, it upheld the individual mandate – the requirement that uninsured but eligible individuals must buy insurance on the exchanges – but struck down the requirement that states expand their Medicaid programs, leaving that up to individual states.

The result has been that many states have opted not to accept federal funds to expand their Medicaid programs. Sadly, many of these states are exactly those that have large populations of uninsured people who would have been covered and now remain unable to access insurance and, by extension, decent care. See for yourself on this interactive map.

I find this not only ironic, but also shameful, heartless and unnecessary.

Author

This blog isn’t about sharing information; it’s about starting conversations. And since good conversations require good listening, I decided to call this blog “Auscultation.” Ira Nash, MD, FACC, FAHA, FACP

The views expressed here are solely the personal views of Ira Nash, MD and do not necessarily represent the policy or position of Northwell Health Physician Partners, Northwell Health or any of their affiliates, employees or physicians.

About Ira Nash, MD

Ira Nash, MD is the Executive Director of Northwell Health Physician Partners, and Senior Vice President of Northwell Health, and a professor of Cardiology and Population Health at Hofstra Northwell School of Medicine.